Sciatica? What exactly is sciatica? You may have heard the term banded about a lot. Even this last week, we have heard Adele and Chris Evans speaking publicly about their struggles with sciatica.
Like many medical terms there can be a lot of confusion about what it really means! But don’t worry, even clinicians can get confused about the true term sciatica.
Firstly, it’s important to understand that ‘sciatica’ is not a diagnosis. Sciatica is a symptom related to an underlying condition.
Sciatica symptoms are commonly the sensation of pain, tingling, weakness, and/or numbness in one or both legs. The symptoms are typically caused by compression or irritation of a spinal nerve(s) or of the sciatic nerve itself. So ‘true’ sciatica is any pain that arises from the sciatic nerve – simple!
So how do you know if you have ‘true’ sciatica?
Well there are essentially 3-types of pain that effect the musculoskeletal system:
- radicular
- somatic
- visceral
As physio’s we deal mainly in the radicular and somatic, which are defined as:
Radicular Pain is a type of pain that is caused by irritation or compression of a spinal nerve root. The pain is referred and typically felt in a specific area of the body that is served by the affected nerve, such as the neck, arm, lower back, or leg. In the case of sciatica, this is your lower back.
Radicular pain is felt when something puts pressure on the spinal nerves. You may feel a shooting pain, tingling, numbness, or weakness in the affected area. Pain tends to be deep, dull and diffuse. Think of toothache travelling down your leg that can be aggravated at times and feel like a sharp, electric like pain. The severity of the pain can vary depending on the extent of nerve damage and the underlying cause of the condition.
Somatic Pain is a type of pain that comes from the skin, muscles, bones, and other tissues of the body. It is usually described as a sharp, aching, or throbbing pain, and can be caused by injury, inflammation, or damage to the tissues. Examples of somatic pain may be a fracture, muscle tear or joint sprain. It is different to referred pain, as the pain is felt where the issue is.
Visceral Pain is a type of pain comes from internal organs of the body, such as your heart, lungs, liver, pancreas, or intestines. It is usually described as a deep, dull, aching, or cramping sensation, and can be difficult to locate precisely. Visceral pain may cause referred pain, which is pain that is felt in a different part of the body than where the problem is occurring.
With sciatica, it is crucial to identify the type of injury or structure(s) involved, where the sciatic nerve compression is, so and therefore the actual source of the pain . This will ensure that your treatment plan and rehabilitation is effective.
Unfortunately in many cases of sciatica it isn’t always simple or clear cut, especially in the more severe or long-standing cases, as over time secondary issues can develop. For example, somatic and radicular pains can overlap in the same case, so there may be 2 types of issues; one from the nerve root with radicular sciatica pain overlaid with another type of pain from the soft tissues (somatic).
Because the picture can be confusing once you actually decide to seek help with your sciatica, it’s very important that you are assessed by an experienced and knowledgable Clinician (whether that be a Physio, Sports Therapist, Osteopath, Chiropractor or other health professional). During your assessment your Clinician should identify the chronological order of your symptom progression and really get a true understanding of your story so various symptoms can be teased apart like the layers of an onion and treatment prioritised accordingly. If your Clinician identifies and addresses the underlying cause, often the secondary elements will ease dramatically with treatment and time.
Unfortunately, what often happens is the in-experienced clinician will get confused between the symptoms and that’s when treatment can go around in circles. You may experience short term benefit, but it doesn’t last.Ultimately, you may come to the conclusion that treatment is not helping and be referred on for surgery, that might otherwise have been avoided with a clearer, more methodical and experienced approach.
It is no wonder patients, GP’s and Clinicians often get confused. We even heard of a case where a patient had somatic, referred pain from a gluteal muscle issue and ended up having spinal surgery with zero change in symptoms after their operation. This was because his pain wasn’t radicular (referred from his nerve root) but instead it was referred from his hips and gluteals (somatic) – poor guy.
So, in a nutshell, if you think you are experiencing sciatica symptoms, it’s important to seek help from an experienced and knowledgable Clinician, who can determine the underlying cause of your symptoms and develop an effective treatment plan to give you the best outcome.
Read More